Why we weren’t ready for Ebola

Peter Piot co-discovered the deadly virus nearly 40 years ago, but says it wasn’t thought a major public health threat – until now

You discovered the Ebola virus in 1976. How?My lab received a blood sample from a Belgian nun who had died in Zaire (now the Democratic Republic of the Congo). She was diagnosed with yellow fever, but when we isolated the virus, it didn’t look like anything we knew. Under the electron microscope it looked like a worm.

Then we got news from the World Health Organization of a major epidemic with a very high mortality rate in Zaire. We were told to stop all investigations because our lab wasn’t equipped to deal with dangerous viruses. So we sent the virus to the US Centers for Disease Control in Atlanta. They confirmed that it was a new virus.

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What happened next?The next step was to figure out how the virus was transmitted and to stop the epidemic. So I went with a team to the epidemic zone in the equatorial forest in the northern part of Zaire. It was my first time ever in Africa, and I was just 27 so I had zero experience. But we did the detective work, unravelling how this virus was spreading.

Nearly 40 years after the virus was found, are you surprised at how bad the situation is?Yes. This Ebola epidemic has killed more people than all the other epidemics together. It is a perfect storm&colon; a virus hiding in the forest, likely in bats; people who are more exposed to the forest due to deforestation and other factors; no trust in authorities after decades of civil war and a corrupt regime; and a dysfunctional health system. You also have strong beliefs about disease causation, traditional funeral rites that require the family to touch the body and mistrust in Western medicine. Finally, there is the very slow response – both nationally and by the international community.

How was the international response lacking?We were all far too late. Even today with the much enhanced support, we are still running behind the virus. The epidemic is expanding. Every week the number of deaths is greater than the week before.

Experimental treatments are now being tested. Why hasn’t this happened sooner?After the 2001 anthrax scare, an anti-bioterrorism programme largely funded by the US Department of Defense led to the development of a few vaccines and experimental drugs for Ebola. But the funding dried up. Until now, Ebola hasn’t been a real public health issue compared with HIV, malaria, maternal mortality and so on. But now we must accelerate evaluation of experimental vaccines and offer some of the drugs for palliative use.

What are the most promising treatments?We still need to go through human trials for a potential vaccine, but that will take months and might well be too late for this epidemic.

For treatment, we can use blood plasma or serum from people who have recovered from Ebola – when you recover from an infectious disease you have very high levels of antibodies in your blood. But let’s make sure treatments are well evaluated. For the next epidemic we need to have stockpiles of vaccine and drugs that can be mobilised immediately.

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Peter Piot is a professor of global health and director of the London School of Hygiene and Tropical Medicine. In 1976 he co-discovered the Ebola virus while working at the Institute of Tropical Medicine in Antwerp, Belgium